Prognosis

Carcinoma of anal margin/perianal skin is treated primarily by surgery ± radiotherapy. Anal canal squamous carcinoma responds well to primary radio-/chemotherapy and abdominoperineal resection is reserved for extensive/recurrent/non-responsive tumours or other lesions such as malignant melanoma and leiomyosarcoma. Perianal carcinoma: 5-year survival 85%; anal canal carcinoma: 5-year survival 65-80%. Adverse prognostic indicators are advanced stage or depth of spread, tumour in inguinal nodes (10-50%) and post-treatment recurrence in the pelvic and perianal regions, e.g. pT1 carcinoma has a 5-year survival of 91%, pT3 16%. Histological grade is not a strong indicator but may be helpful in poorly differentiated squamous cell carcinoma of large cell type. Ductal differentiation in basaloid carcinoma is an adverse factor. Recurrence in men is pelvic and perineal, in women pelvic and vaginal.

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